There is poison in every breath you take

Although no one has teased out the numbers, add cancer, heart and respiratory diseases caused by the toxins we breathe and air pollution might rocket to the top of Indian kill charts, writes Samar Halarnkar.

Earlier this week, in the babble and bombast over Gandhi vs Modi, a seminal announcement from Lyon, France, with great — and grave — relevance to India, escaped the attention it deserved.

The International Agency for Research on Cancer (IARC) announced, for the first time, that air pollution causes lung cancer.

It also said that poisoned air’s major component, particulate matter — smoke, dust and other dirty byproducts of road traffic, factories and construction — must now be classified a carcinogen, a cancer-causing substance, alongside tobacco, asbestos and ultraviolet radiation.

This is an announcement on par with the first warnings against tobacco or global warming. The IARC reviewed 1,000 scientific papers on five continents before going public. Previously only specific components of air pollution, such as diesel exhausts, were implicated in cancers.

Some of the cities whose citizens are most at risk lie in India and China (though the most poisoned cities are in Iran). Although India is less industrialised than China, Indian cities, according to the IARC, are far worse off.

Air pollution levels in Lanzhou, China’s most-polluted city, are lower than all of India’s top five. Bangalore is worse than Shanghai and Beijing is better than Mumbai. The city with the most poisoned air? Ludhiana, with pollution levels 10 times higher than Los Angeles.

A complex mix of toxic particles and gases, air pollution is the now the mother cause of many so-called lifestyle diseases that have emerged as the leading reasons for death in India and much of the emerging world. Before the new link to cancer, toxic air has already been implicated in the rise of heart and respiratory diseases.

Many studies have shown how poisoned air leads to lower productivity and widespread ill-health, enough to lower a nation’s output. Air pollution costs India about $30 billion, or 3% of GDP, according to the World Bank.

Three years ago, air pollution was the fifth biggest killer in India, responsible for a quarter of all strokes, 48.6% of ischemic heart disease and 620,000 premature deaths — the last, a 600% increase over a decade — according to the World Health Organisation’s Global Burden of Disease study.

Although no one has teased out the numbers, add cancer, heart and respiratory diseases caused by the toxins we breathe and air pollution might rocket to the top of Indian kill charts.

Particulate matter less than 10 micrometres — officially called PM10, many times finer than a human hair — is the primary measure of air pollution in India. These microscopic bits and bobs of progress burrow deep into the respiratory system.

India faces a grim predicament. Of 400 locations monitored by the Central Pollution Control Board — the word “control” is a misnomer — 99% report unsafe levels of PM10, according to a 2013 analysis of national air quality data by the Centre for Science and Environment. Ninety cities and town report critical air-pollution levels and 23 are most critical, which means they exceed safety limits by 300% or more.

Delhi is the only metropolis in CSE’s top five. The rest are Gwalior, Ghaziabad, Raipur and West Singhbhum. The cancer report from earlier this week has a top five list with only Delhi in common. The others are Ludhiana, Kanpur, Lucknow and Indore.

The cities may differ, but the inference is clear: exploding small-town India, with its third-rate technology and virtually no pollution control, is most at risk from the deadly effects of air pollution.

Measuring air pollution is tricky. PM10 is the most widely discussed contaminant, but there are others of growing concern. Extra-fine particles smaller than 2.5 micrometers, or PM2.5, can go further into the lungs and airway and carry more dangerous toxins, such as heavy metals. The carcinogenic effects of such particles were a special focus of the IARC study.

Another pollutant of concern is nitrogen oxide (NO2), a smelly, toxic gas, creating ozone on the ground — a major component of smog — and acid in the air. The gas, a product of vehicular engines and factories, irritates the eyes, nose, throat, causes shortness of breath and aggravates respiratory illnesses, such as asthma, especially in young children.

While levels of NO2 in Indian cities are lower than in the West, concentrations of the gas doubled or tripled between 1996 and 2011, said a study published this April in the international journal Atmospheric Chemistry and Physics.

Technology, techniques and practices can certainly slow air pollution — as they have in many countries — and will not cost anything as much as the $-30-billion economic hole that will result if they are not. But such fixes require a vision that short-sighted India, its leaders, wannabe leaders and companies (with a few honourable exceptions), mostly ignore. With the population continuing to rise, delay will cause an exponential rise in health costs.

There are two aspects to prevention — paring pollution and disease. Controlling pollution is a tall order. It depends on governance issues, at which India so spectacularly fails.

A better way would be to incentivise and tax industry, the latter method, admittedly, a risk in a time of corporate gloom. The World Bank estimates that a “PM10 tax” on industries and products that boost such pollution, could net $59 billion.

Disease prevention may be a trifle easier. Half of all cancers are preventable, and early screening and treatment could hold back the tide. Heart disease and respiratory ailments can be similarly curtailed.

India and its decrepit public health infrastructure will struggle with the sheer numbers, but a slew of low-cost, mass-scale fixes could emerge in the next three years from determined start-ups and privately run big medicine.

Over the last decade, the vulnerability of Indians to overall pollution has increased greatly. In a World Bank report released in July, India ranked 126 of 132 countries graded for environmental performance, behind China, Pakistan and Bangladesh.

For the effects of air pollution on its citizens, India ranked last — yes, 132 of 132.